Robotic bi-polar instruments

ABSTRACT

Various exemplary systems, devices, and methods for robotic bi-polar instruments are provided. In general, a surgical tool can include an elongate shaft, an end effector, a wrist that couples the end effector to the shaft at a distal end of the shaft, and a tool housing coupled to a proximal end of the shaft that is configured to control the operation various features associated with the end effector and to operatively couple to a robotic surgical system.

CROSS REFERENCE

The present application is a continuation of U.S. patent applicationSer. No. 15/451,483 entitled “Robotic Bi-Polar Instruments” filed Mar.7, 2017, which claims priority to U.S. Provisional Patent ApplicationNo. 62/304,716 entitled “Robotic Bi-Polar Instruments” filed Mar. 7,2016, which are hereby incorporated by reference in their entireties.

FIELD

Methods, systems, and devices are provided for robotic surgery, and inparticular bi-polar instruments.

BACKGROUND

Minimally invasive surgical (MIS) instruments are often preferred overtraditional open surgical devices due to the reduced post-operativerecovery time and minimal scarring. Laparoscopic surgery is one type ofMIS procedure in which one or more small incisions are formed in theabdomen and a trocar is inserted through the incision to form a pathwaythat provides access to the abdominal cavity. The trocar is used tointroduce various instruments and tools into the abdominal cavity, aswell as to provide insufflation to elevate the abdominal wall above theorgans. The instruments and tools can be used to engage and/or treattissue in a number of ways to achieve a diagnostic or therapeuticeffect. Endoscopic surgery is another type of MIS procedure in whichelongate flexible shafts are introduced into the body through a naturalorifice.

Although traditional minimally invasive surgical instruments andtechniques have proven highly effective, newer systems may provide evenfurther advantages. For example, traditional minimally invasive surgicalinstruments often deny the surgeon the flexibility of tool placementfound in open surgery. Difficulty is experienced in approaching thesurgical site with the instruments through the small incisions.Additionally, the added length of typical endoscopic instruments oftenreduces the surgeon's ability to feel forces exerted by tissues andorgans on the end effector. Furthermore, coordination of the movement ofthe end effector of the instrument as viewed in the image on thetelevision monitor with actual end effector movement is particularlydifficult, since the movement as perceived in the image normally doesnot correspond intuitively with the actual end effector movement.Accordingly, lack of intuitive response to surgical instrument movementinput is often experienced. Such a lack of intuitiveness, dexterity, andsensitivity of endoscopic tools has been found to be an impediment inthe increased the use of minimally invasive surgery.

Over the years a variety of minimally invasive robotic systems have beendeveloped to increase surgical dexterity as well as to permit a surgeonto operate on a patient in an intuitive manner. Telesurgery is a generalterm for surgical operations using systems where the surgeon uses someform of remote control, e.g., a servomechanism, or the like, tomanipulate surgical instrument movements, rather than directly holdingand moving the tools by hand. In such a telesurgery system, the surgeonis typically provided with an image of the surgical site on a visualdisplay at a location remote from the patient. The surgeon can typicallyperform the surgical procedure at the location remote from the patientwhilst viewing the end effector movement on the visual display duringthe surgical procedure. While viewing typically a three-dimensionalimage of the surgical site on the visual display, the surgeon performsthe surgical procedures on the patient by manipulating master controldevices at the remote location, which master control devices controlmotion of the remotely controlled instruments.

While significant advances have been made in the field of roboticsurgery, there remains a need for improved methods, systems, and devicesfor use in robotic surgery.

SUMMARY

In general, systems, devices, and methods for robotic bi-polarinstruments are provided.

In one aspect, a surgical device is provided that in one embodimentincludes an elongate shaft, a pair of jaws at a distal end of theelongate shaft, a cable configured to be actuated and thereby move in aproximal direction, a slidable member operatively engaged with the cableand being configured to slide in a distal direction in response to themovement of the cable in the proximal direction, and a link operativelycoupled with the slidable member and with the cable. The sliding of theslidable member is configured to cause the link to pivot and therebycause the pair of jaws to open. The pair of jaws are configured toengage tissue therebetween and apply energy thereto.

The surgical device can vary in any number of ways. For example, thesurgical device can include a second cable operatively engaged with theslidable member, configured to move in the proximal direction to causethe pair of jaws to close, and configured to slide in the proximaldirection in response to the movement of the second cable in theproximal direction, and the sliding of the slidable member in theproximal direction can be configured to cause the link to pivot andthereby cause the pair of jaws to close. In at least some embodiments,the cable can be attached to one of a proximal end and a distal end ofthe slidable member, and the second cable can be attached to the otherof the proximal end and the distal end of the slidable member. In atleast some embodiments, the cable can be configured to move in thedistal direction when the second cable is moving in the proximaldirection, and the second cable can be configured to move in the distaldirection when the cable is moving in the proximal direction. In atleast some embodiments, the surgical device can include a housing havingthe elongate shaft extending distally therefrom, and the housing caninclude a first rotary member configured to rotate to cause the movementof the cable in the distal direction and can include a second rotarymember configured to rotate to cause the movement of the second cable inthe proximal direction. The housing can be configured to be coupled to atool driver of a robotic surgical system that provides inputs to thefirst and second rotary members to cause the rotation thereof.

For another example, the surgical device can include a pulley having thecable operatively engaged therewith, with trailing ends of the cableextending proximally from the pulley. For yet another example, the cablecan be configured to be actuated and thereby move in the proximaldirection, the slidable member can be configured to slide in the distaldirection in response to the movement of the cable in the proximaldirection, and the sliding of the slidable member in the distaldirection can be configured to cause the link to pivot and thereby causethe pair of jaws to close. For still another example, the surgicaldevice can include a housing having the elongate shaft extendingdistally therefrom, and the housing can include a first rotary memberconfigured to rotate to cause the movement of the cable in the proximaldirection. For another example, the surgical device can include a rodextending along the elongate shaft, and the slidable member can beconfigured to slide along the rod. For yet another example, the surgicaldevice can include a bias member that biases the pair of jaws closed.For another example, the surgical device can include an articulationcable configured to be actuated and thereby cause the pair of jaws toarticulate relative to the elongate shaft, and an energy cableconfigured to deliver energy for the pair of jaws to apply to theengaged tissue.

In another embodiment, a surgical device includes an elongate shaft, anend effector configured to engage tissue and apply energy thereto, acutting element configured to move longitudinally along the end effectorto cut tissue engaged by the end effector, a cutting element cableconfigured to be actuated to cause the movement of the cutting element,and a pulley at a distal end of the end effector and operatively coupledto the cutting element cable such that the cutting element cable slidesalong the pulley during the movement of the cutting element.

The surgical device can have any number of variations. For example, thecutting element cable can be configured to be pushed distally to causethe movement of the cutting element. For another example, the surgicaldevice can include an articulation cable configured to be actuated andthereby cause the pair of jaws to articulate relative to the elongateshaft, a closure cable configured to be actuated and thereby cause thepair of jaws to close, and an energy cable to configured to deliverenergy for the pair of jaws to apply to the engaged tissue.

In another aspect, a surgical method is provided that in one embodimentincludes advancing jaws at a distal end of a surgical tool into apatient. The surgical tool is configured to apply energy to tissueengaged by the end effector. The surgical method also includes causing acable that extends along the elongate shaft to move proximally tothereby cause a slidable member operatively engaged with the cable toslide distally. The distal sliding of the slidable member causes a linkto pivot and thereby cause the jaws to open.

The surgical method can vary in any number of ways. For example, thesurgical method can include causing a second cable that extends alongthe elongate shaft to move proximally to thereby cause the slidablemember operatively engaged with the second cable to slide proximally.The proximal sliding of the slidable member in response to the movementof the second cable can cause the link to pivot and thereby cause thejaws to close. In at least some embodiments, causing the cable to moveproximally includes providing an input to the surgical tool from arobotic surgical system having the surgical tool coupled thereto, andcausing the second cable to move proximally includes providing anotherinput to the surgical tool from the robotic surgical system having thesurgical tool coupled thereto.

For another example, the surgical method can include causing the cableto move distally to thereby cause the slidable member to slideproximally. The proximal sliding of the slidable member can cause thelink to pivot and thereby cause the jaws to close.

For yet another example, causing the cable to move proximally caninclude providing an input to the surgical tool from a robotic surgicalsystem having the surgical tool coupled thereto.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a side schematic view of one embodiment of a surgical tool;

FIG. 2 is a graphical representation of terminology associated with sixdegrees of freedom;

FIG. 3 is a perspective view of one embodiment of a robotic surgicalsystem that includes a patient-side portion and a user-side portion;

FIG. 4 is a perspective view of one embodiment of a robotic arm of arobotic surgical system with the surgical tool of FIG. 1 releasably andreplaceably coupled to the robotic arm;

FIG. 5 is a perspective view of a tool driver of the robotic arm of FIG.4;

FIG. 6 is a perspective view of a distal portion of another embodimentof a surgical tool;

FIG. 7 is another perspective, partially transparent view of a distalportion of the tool of FIG. 6;

FIG. 7A is yet another perspective, partially transparent view of adistal portion of the tool of FIG. 6;

FIG. 8 is a side view of a distal portion of the tool of FIG. 6;

FIG. 8A is another perspective, partially transparent view of a distalportion of the tool of FIG. 6;

FIG. 8B is still another perspective, partially transparent view of adistal portion of the tool of FIG. 6;

FIG. 8C is a top view of a distal portion of the tool of FIG. 6;

FIG. 9 is a side, partially transparent view of a distal portion of thetool of FIG. 6;

FIG. 10 is a side, partially transparent view of a portion of anotherembodiment of a surgical tool with an end effector thereof in an openposition;

FIG. 11 is a side, partially transparent view of the portion of the toolof FIG. 10 with the end effector in a closed position;

FIG. 12 is a side, partially transparent view of a portion of yetanother embodiment of a surgical tool with an end effector thereof in anopen position;

FIG. 13 is a side, partially transparent view of the portion of the toolof FIG. 12 with the end effector in a closed position;

FIG. 14 is a perspective, partially transparent view of the portion ofthe tool of FIG. 11 with the end effector in the open position;

FIG. 15 is a perspective, partially transparent view of a portion ofanother embodiment of a surgical tool with an end effector thereof in anopen position;

FIG. 16 is a perspective, partially transparent view of a portion of yetanother embodiment of a surgical tool with an end effector thereof in anopen position;

FIG. 17 is a perspective, partially transparent view of a distal portionof the tool of FIG. 16 with the end effector in a closed position;

FIG. 18 is a perspective, partially transparent view of a portion of thetool of FIG. 16 with the end effector in the open position;

FIG. 19 is a side view of a portion of the tool of FIG. 16;

FIG. 20 is a schematic view of an arrangement of cables at a firstposition along the tool of FIG. 19;

FIG. 21 is a schematic view of an arrangement of cables at second andthird positions along the tool of FIG. 19;

FIG. 22 is a schematic view of an arrangement of cables at a fourthposition along the tool of FIG. 19;

FIG. 23 is a top, partially transparent view of a tool housing of thetool of FIG. 16;

FIG. 24 is another top, partially transparent view of the tool housingof FIG. 23;

FIG. 25 is a perspective, partially cut away view of the tool housing ofFIG. 23;

FIG. 26 is a perspective view of a portion of the tool housing of FIG.23 including a winch and bias member;

FIG. 27 is a perspective view of the winch and bias member of FIG. 26;

FIG. 28 is a side, partially transparent schematic view of a proximalportion of yet another embodiment of a surgical tool;

FIG. 29 is a schematic, partial view of another embodiment of a surgicaltool;

FIG. 30 is a perspective, partially transparent view of a proximalportion of still another embodiment of a surgical tool;

FIG. 31 is a perspective view of a first articulation mechanism of thetool of FIG. 30;

FIG. 32 is a perspective view of a second articulation mechanism of thetool of FIG. 30;

FIG. 33 is a perspective view of a cutting element translation mechanismof the tool of FIG. 30;

FIG. 34 is a perspective view of a closure mechanism of the tool of FIG.30;

FIG. 35 is a schematic cross-sectional view of another embodiment of asurgical tool;

FIG. 36 is a side cross-sectional view of a portion of the tool of FIG.35;

FIG. 37 is a side view of a portion of the tool of FIG. 35;

FIG. 38 is a side view of a portion of one embodiment of a hypotube;

FIG. 39 is a side view of a portion of another embodiment of a hypotube;

FIG. 40 is a perspective view of a portion of yet another embodiment ofa hypotube;

FIG. 41 is a schematic cross-sectional view of still another embodimentof a surgical tool;

FIG. 42 is a schematic cross-sectional view of yet another embodiment ofa surgical tool;

FIG. 43 is a cross-sectional view of another embodiment of a surgicaltool;

FIG. 44 is a side view of a distal portion of the tool of FIG. 43;

FIG. 44A is a perspective view of a portion of the tool of FIG. 43;

FIG. 45 is a perspective view of a distal portion of another embodimentof a surgical tool;

FIG. 46 is a perspective view of a distal portion of yet anotherembodiment of a surgical tool;

FIG. 47 is a perspective view of a distal portion of the tool of FIG.46;

FIG. 48 is a top view of a distal portion of the tool of FIG. 46;

FIG. 49 is another view of a distal portion of the tool of FIG. 46;

FIG. 50 is a perspective, partially transparent view of a proximalportion of the tool of FIG. 46;

FIG. 51 is a perspective view of an articulation and closure mechanismof the tool of FIG. 50;

FIG. 52 is a perspective view of a cutting element translation mechanismof the tool of FIG. 50;

FIG. 53 is a perspective view of a distal portion of still anotherembodiment of a surgical tool;

FIG. 54 is a schematic view of forces on the tool of FIG. 53;

FIG. 55 is a perspective view of a distal portion of another embodimentof a surgical tool;

FIG. 56 is a perspective view of a flexible neck of the tool of FIG. 55;

FIG. 57 is a side, partial view of the flexible neck of FIG. 55 with theflexible neck flexed;

FIG. 58 is a side, partial view of the flexible neck of FIG. 55 with theflexible neck unflexed;

FIG. 59 is a perspective view of a distal portion of still anotherembodiment of a surgical tool; and

FIG. 60 is a schematic view of one embodiment of a computer system.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

Various exemplary systems, devices, and methods for robotic bi-polarinstruments are provided.

FIG. 1 illustrates one embodiment of a surgical tool 10 that includes anelongate shaft 12, an end effector 14, a wrist 16 that couples the endeffector 14 to the shaft 12 at a distal end of the shaft 12, and a toolhousing 18 coupled to a proximal end of the shaft 12. The end effector14 is configured to move relative to the shaft 12 at the wrist 16, e.g.,by pivoting at the wrist 16, to position the end effector 14 at adesired location relative to a surgical site during use of the tool 10.The housing 18 includes various components (e.g., gears and/oractuators) configured to control the operation various featuresassociated with the end effector 14 (e.g., any one or more of clamping,firing, rotation, articulation, energy delivery, etc.). In at least someembodiments, the shaft 12, and hence the end effector 14 coupledthereto, is configured to rotate about a longitudinal axis A1 of theshaft 12. In such embodiments, the various components of the housing 18are configured to control the rotational movement of the shaft 12. In atleast some embodiments, as in this illustrated embodiment, the surgicaltool 10 is configured to releasably couple to a robotic surgical system,and the tool housing 18 can include coupling features configured toallow the releasable coupling of the tool 10 to the robotic surgicalsystem. Each of the shaft 12, end effector 14, wrist 16, and housing 18are discussed further below.

The surgical tool 10 can have any of a variety of configurations. Ingeneral, the surgical tool can be configured to perform at least onesurgical function and can include any of, for example, forceps, agrasper, a needle driver, scissors, an electrocautery tool that appliesenergy, a stapler, a clip applier, a suction tool, an irrigation tool,an imaging device (e.g., an endoscope or ultrasonic probe), etc. Thesurgical tool 10 in at least some embodiments is configured to applyenergy (such as radiofrequency (RF) energy) to tissue, while in otherembodiments the tool 10 is not configured to apply energy to tissue.

The shaft 12 can have any of a variety of configurations. In general,the shaft 12 is an elongate member extending distally from the housing18 and having at least one inner lumen extending therethrough. The shaft12 is fixed to the housing 18, but in other embodiments the shaft 12 canbe releasably coupled to the housing 18 such that the shaft 12 can beinterchangeable with other shafts. This may allow a single housing 18 tobe adaptable to various shafts having different end effectors.

The end effector 14 can have a variety of sizes, shapes, andconfigurations. The end effector 14 includes a tissue grasper having apair of opposed jaws 20, 22 configured to move between open and closedpositions with one or both of the jaws 20, 22 configured to pivot at thewrist 16 to move the end effector 14 between the open and closedpositions. The end effector 14 in other embodiments can have otherconfigurations, e.g., scissors, a babcock, a retractor, etc.

The wrist 16 can have any of a variety of configurations. Exemplaryembodiments of a wrist of a surgical tool and of effecting articulationat the wrist are described in International Pat. Pub. No. WO 2014/151952entitled “Compact Robotic Wrist” filed on Mar. 13, 2014, InternationalPat. Pub. No. WO 2014/151621 entitled “Hyperdexterous Surgical System”filed on Mar. 13, 2014, U.S. Pat. No. 9,055,961 entitled “Fusing AndCutting Surgical Instrument And Related Methods” filed on Feb. 17, 2012,U.S. patent application Ser. No. 15/200,283 entitled “Methods, Systems,And Devices For Initializing A Surgical Tool” filed on Jul. 1, 2016, andU.S. patent application Ser. No. 15/237,648 entitled “Methods, Systems,And Devices For Causing End Effector Motion With A Robotic SurgicalSystem” filed on Aug. 16, 2016, which are hereby incorporated byreference in their entireties. In general, the wrist 16 can include ajoint configured to allow movement of the end effector 14 relative tothe shaft 12, such as a pivot joint at which the jaws 20, 22 arepivotally attached. In some embodiments, the pivoting motion can includepitch movement about a first axis of the wrist 16 (e.g., a X axis), yawmovement about a second axis of the wrist 16 (e.g., a Y axis), andcombinations thereof to allow for 360° rotational movement of the endeffector 14 about the wrist 16. In other embodiments, the pivotingmotion can be limited to movement in a single plane, e.g., only pitchmovement about the first axis of the wrist 16 or only yaw movement aboutthe second axis of the wrist 16, such that end effector 14 rotates in asingle plane.

FIG. 2 illustrates degrees of freedom of a system represented by threetranslational or position variables, e.g., surge, heave, sway, and bythree rotational or orientation variables, e.g., Euler angles or roll,pitch, yaw, that describe the position and orientation of a component ofa surgical system with respect to a given reference Cartesian frame. Asused herein, and as illustrated in FIG. 2, the term “surge” refers toforward and backward movement, the term “heave” refers to movement upand down, and the term “sway” refers to movement left and right. Withregard to the rotational terms, “roll” refers to tilting side to side,“pitch” refers to tilting forward and backward, and “yaw” refers toturning left and right.

The movement of the end effector 14 in this illustrated embodimentincludes articulating movement of the end effector 14 between anunarticulated position, in which the end effector 14 is substantiallylongitudinally aligned with the shaft 12 (e.g., a longitudinal axis A2of the end effector 14 is substantially aligned with the longitudinalaxis A1 of the shaft 12 such that the end effector 14 is at asubstantially zero angle relative to the shaft 12), and an articulatedposition, in which the end effector 14 is angularly orientated relativeto the shaft 12 (e.g., the longitudinal axis A2 of the end effector 14is angled relative to the longitudinal axis A1 of the shaft 12 such thatthe end effector 14 is at a non-zero angle relative to the shaft 12). Aperson skilled in the art will appreciate that the end effector 14 maynot be precisely aligned with the shaft 12 (e.g., may not be at aprecise zero angle relative thereto) but nevertheless be considered tobe aligned with the shaft 12 (e.g., be at a substantially zero angle)due to any number of factors, such as manufacturing tolerance andprecision of measurement devices. The end effector 14 is shown in theunarticulated position in FIG. 1. The movement of the end effector 14 inthis illustrated embodiment also includes rotational movement of the endeffector 14 in which the end effector 14 rotates about its longitudinalaxis A2, either with or without corresponding rotation of the shaft 12about its longitudinal axis A1.

The surgical tool 10 can include one or more actuation shafts configuredto facilitate movement of the end effector 14. Each of the one or moreactuation shafts can extend along the shaft 12 (e.g., in an inner lumenthereof) and can be operatively coupled to the housing 18 and to the endeffector 14. In this way, a tool driver coupled to the housing 18 can beconfigured to provide input to the surgical tool 10 via the tool housing18 and thereby actuate the one or more actuation shafts to causemovement of the end effector 14.

The systems, devices, and methods disclosed herein can be implementedusing a robotic surgical system. As will be appreciated by a personskilled in the art, electronic communication between various componentsof a robotic surgical system can be wired or wireless. A person skilledin the art will also appreciate that all electronic communication in therobotic surgical system can be wired, all electronic communication inthe robotic surgical system can be wireless, or some portions of therobotic surgical system can be in wired communication and other portionsof the system can be in wireless communication.

FIG. 3 is a perspective view of one embodiment of a robotic surgicalsystem 100 that includes a patient-side portion 102 that is positionedadjacent to a patient 104, and a user-side portion 106 that is located adistance from the patient, either in the same room and/or in a remotelocation. The patient-side portion 102 generally includes one or morerobotic arms 108 and one or more tool assemblies 110 that are configuredto releasably couple to a robotic arm 108. The user-side portion 106generally includes a vision system 112 for viewing the patient 104and/or surgical site, and a control system 114 for controlling themovement of the robotic arms 108 and each tool assembly 110 during asurgical procedure.

The control system 114 can have a variety of configurations and can belocated adjacent to the patient (e.g., in the operating room), remotefrom the patient (e.g., in a separate control room), or distributed attwo or more locations (e.g., the operating room and/or separate controlroom(s)). As an example of a distributed system, a dedicated systemcontrol console can be located in the operating room, and a separateconsole can be located in a remote location. The control system 114 caninclude components that enable a user to view a surgical site of thepatient 104 being operated on by the patient-side portion 102 and/or tocontrol one or more parts of the patient-side portion 102 (e.g., toperform a surgical procedure at the surgical site). In some embodiments,the control system 114 can also include one or more manually-operatedinput devices, such as a joystick, exoskeletal glove, a powered andgravity-compensated manipulator, or the like. The one or more inputdevices can control teleoperated motors which, in turn, control themovement of the surgical system, including the robotic arms 108 and toolassemblies 110.

The patient-side portion 102 can have a variety of configurations. Asillustrated in FIG. 3, the patient-side portion 102 can couple to anoperating table 116. However, in other embodiments, the patient-sideportion 102 can be mounted to a wall, to the ceiling, to the floor, orto other operating room equipment. Further, while the patient-sideportion 102 is shown as including two robotic arms 108, more or fewerrobotic arms 108 may be included. Furthermore, the patient-side portion102 can include separate robotic arms 108 mounted in various positions,such as relative to the surgical table 116 (as shown in FIG. 3).Alternatively, the patient-side portion 102 can include a singleassembly that includes one or more robotic arms 108 extending therefrom.

FIG. 4 illustrates another embodiment of a robotic arm 118 and thesurgical tool 10 of FIG. 1 releasably and replaceably coupled to therobotic arm 118. Other surgical instruments can instead be coupled tothe arm 118, as discussed herein. The robotic arm 118 is configured tosupport and move the associated tool 10 along one or more degrees offreedom (e.g., all six Cartesian degrees of freedom, five or fewerCartesian degrees of freedom, etc.).

The robotic arm 118 can include a tool driver 122 at a distal end of therobotic arm 118, which can assist with controlling features associatedwith the tool 10. The robotic arm 118 can also include an entry guide123 (e.g., a cannula mount, cannula, etc.) that can be a part of orreleasably and replaceably coupled to the robotic arm 118, as shown inFIG. 4. A shaft of a tool assembly can be inserted through the entryguide 123 for insertion into a patient, as shown in FIG. 4 in which theshaft 12 of the tool 10 of FIG. 1 is shown inserted through the entryguide 123.

In order to provide a sterile operation area while using the surgicalsystem, a barrier 126 can be placed between the actuating portion of thesurgical system (e.g., the robotic arm 118) and the surgical instrumentscoupled thereto (e.g., the tool 10, etc.). A sterile component, such asan instrument sterile adapter (ISA), can also be placed at theconnecting interface between the tool 10 and the robotic arm 118. Theplacement of an ISA between the tool 10 and the robotic arm 108 canensure a sterile coupling point for the tool 10 and the robotic arm 118.This permits removal of surgical instruments from the robotic arm 118 toexchange with other surgical instruments during the course of a surgerywithout compromising the sterile surgical field.

FIG. 5 illustrates the tool driver 122 in more detail. As shown, thetool driver 122 includes one or more motors, e.g., five motors 124 areshown, that control a variety of movements and actions associated withthe tool 10 coupled to the arm 118. For example, each motor 124 cancouple to and/or interact with an activation feature (e.g., gear)associated with the tool 10 for controlling one or more actions andmovements that can be performed by the tool 10, such as for assistingwith performing a surgical operation. The motors 124 are accessible onthe upper surface of the tool driver 122, and thus the tool 10 (e.g.,the housing 18 thereof) is configured to mount on top of the tool driver122 to couple thereto. Exemplary embodiments of motor operation andcomponents of a tool housing (also referred to as a “puck”) configuredto controlled by tool driver motors are further described in previouslymentioned International Patent Publication No. WO 2014/151952 entitled“Compact Robotic Wrist” filed on Mar. 13, 2014 and International PatentPublication No. WO 2014/151621 entitled “Hyperdexterous Surgical System”filed on Mar. 13, 2014, U.S. patent application Ser. No. 15/200,283entitled “Methods, Systems, And Devices For Initializing A SurgicalTool” filed on Jul. 1, 2016, and in U.S. patent application Ser. No.15/237,653 entitled “Methods, Systems, And Devices For Controlling AMotor Of A Robotic Surgical Systems” filed on Aug. 16, 2016, which ishereby incorporated by reference in its entirety.

The tool driver 122 also includes a shaft-receiving channel 126 formedin a sidewall thereof for receiving the shaft 12 of the tool 10. Inother embodiments, the shaft 12 can extend through on opening in thetool driver 122, or the two components can mate in various otherconfigurations.

FIGS. 6-9 illustrate one embodiment of a surgical tool 200 configured toapply energy to tissue, e.g., is an electrosurgical tool. The tool 200is generally configured and used similar to the tool 10 of FIG. 1, e.g.,includes an elongate shaft 202, an end effector 204, a wrist 206 thatcouples the end effector 204 to the shaft 202 at a distal end of theshaft 202, and a tool housing (not shown) coupled to a proximal end ofthe shaft 202. The tool housing can include a plurality of inputinterfaces configured to operatively couple a tool driver of a surgicalrobot to the surgical tool 200. The end effector 204 in this illustratedembodiment includes opposed lower and upper jaws 210, 212. As shown inFIGS. 6 and 7, each of the lower and upper jaws 210, 212 includes anelectrode 210 e, 212 e configured to deliver energy to tissue engagedbetween the jaws 210, 212, such as by each of the electrodes 210 e, 212e receiving one pole from a bipolar energy source to create bipolarenergy between the electrodes sufficient to fuse tissue. Each of thelower and upper jaws 210, 212 also includes a slot or groove 210 s (theupper jaw's slot or groove is obscured in the figures) extendinglongitudinally therealong that is configured to slidably receive acutting element 214 therein to allow the cutting element 214 to cuttissue engaged between the jaws 210, 212. Exemplary embodiments ofelectrosurgical surgical tools configured to apply energy to tissueincluding are further described in previously mentioned U.S. Pat. No.9,055,961 entitled “Fusing And Cutting Surgical Instrument And RelatedMethods” filed on Feb. 17, 2012.

In general, the wrist 206 can allow for fine movements and angulation ofthe end effector 204 relative to the elongate shaft 202 to which the endeffector 204 is coupled. The tool 200 includes one linkage 208 at thewrist 206 that couples the end effector 204 and shaft 202 together. Thelinkage 208 is configured to facilitate articulation of the end effector204 relative to the elongate shaft 202, e.g., angle the end effector 204relative to a longitudinal axis of the elongate shaft 202. A distal endof the linkage 208 is pivotally coupled at a first or distal joint 216to a proximal end of the end effector 204, e.g., to a proximal end ofthe bottom jaw 210. A proximal end of the linkage 208 is pivotallycoupled at a second or proximal joint 218 to a distal end of the shaft202. The first joint 216 defines a first pivot axis P1 about which theend effector 204 is configured to pivot relative to the linkage 208. Thefirst joint 216 thus defines a first plane in which the end effector 204is configured to move relative to the shaft 202. The second joint 218defines a second pivot axis P2 about which the linkage 208, and hencealso the end effector 204 coupled thereto, is configured to pivotrelative to the shaft 202. The second joint 218 thus defines a secondplane in which the end effector 204 is configured to move relative tothe shaft 202. FIGS. 6-8A and 9 show the end effector 204 in anunarticulated position. FIGS. 7A and 8B show the end effector 204 in anarticulated position, in this illustrated example with the end effector204 articulated to the right.

The tool 200 includes first, second, third, and fourth articulationcables 226 a, 226 b, 226 c, 226 d configured to be actuated to causearticulating movement of the end effector 204 coupled thereto. Thearticulation cables 226 a, 226 b, 226 c, 226 d are operatively coupledto the tool housing and are thus configured to be operatively coupled toa tool driver, via the tool housing. Input from the tool driver to thetool housing can thus be configured to actuate the articulation cables226 a, 226 b, 226 c, 226 d to cause selective movement of selected oneor more of the articulation cables 226 a, 226 b, 226 c, 226 d to causeselected articulation of the end effector 204.

In this illustrated embodiment, the articulation cables 226 a, 226 b,226 c, 226 d are each offset from the first and second pivot axes P1, P2and hence are each offset from the first and second planes respectivelydefined by the first and second pivot axes P1, P2. In other words, thearticulation cables 226 a, 226 b, 226 c, 226 d are not on either axisP1, P2 of articulation motion. The articulation cables 226 a, 226 b, 226c, 226 d are also spaced radially around the longitudinal axis of theelongate shaft 202 equidistantly from one another at about 45° from theaxes P1, P2. This positioning of the articulation cables 226 a, 226 b,226 c, 226 d may allow for the end effector 204 to articulate at amaximum articulation angle in each of pitch and yaw directions of about80°, e.g., +/−80° for each axis P1, P2.

The articulation cables 226 a, 226 b, 226 c, 226 d each extendlongitudinally through the linkage 208. Distal ends of each of thearticulation cables 226 a, 226 b, 226 c, 226 d are fixedly coupled tothe end effector 204, e.g., to the bottom jaw 210. The articulationcables' distal ends can be enlarged (e.g., have an enlarged diameter ascompared to a remainder of the cable's diameter) to facilitate fixedattachment thereof to the end effector 204 via an attachment mechanismsuch as welding, adhesive, press fit, crimping, etc. For clarity ofillustration, the articulation cables 226 a, 226 b, 226 c, 226 d areomitted from FIG. 8.

The linkage 208 has four channels configured to guide the articulationcables 226 a, 226 b, 226 c, 226 d at the first and second joints 216,218 during articulation. The linkage's channels guide the articulationcables 226 a, 226 b, 226 c, 226 d around the bend at the first andsecond joints 216, 218, thereby helping to prevent the articulationcables 226 a, 226 b, 226 c, 226 d from encountering any sharp corners orradii, reducing friction between the articulation cables 226 a, 226 b,226 c, 226 d and the linkage 208, and/or helping to prevent thearticulation cables 226 a, 226 b, 226 c, 226 d from twisting or movingradially inward or outward at either of the first and second joints 216,218 during articulation. Such friction, sharp corners or radiiencounters, and twisting or radial movement may exert more force on thearticulation cables 226 a, 226 b, 226 c, 226 d, which may increase wearon the articulation cables 226 a, 226 b, 226 c, 226 d and thereby reducetheir overall life.

The end effector 204 is configured to move between an open position inwhich the jaws 210, 212 are open and a closed position in which the jaws210, 212 are closed. The end effector 204 is shown in the open positionin FIGS. 6-7A and 9 and is shown in the closed position in FIGS. 8-8B.As shown in FIG. 7, the tool 200 includes first and second closurecables 222 a, 222 b configured to be actuated to cause selective openingand closing of the end effector 204. The closure cables 222 a, 222 b areoperatively coupled to the tool housing and are thus configured to beoperatively coupled to a tool driver, via the tool housing. Input fromthe tool driver to the tool housing can thus be configured to actuatethe closure cables 222 a, 222 b to cause selective movement of theclosure cables 222 a, 222 b to cause selected opening and closing of theend effector 204. For clarity of illustration, the closure cables 222 a,222 b are omitted from FIGS. 6 and 7.

The tool 200 includes a pair of links 224 configured to facilitate theopening and closing of the end effector 204. The links 224 are onopposed sides, e.g., left and right sides, of the end effector 204. Thelinks 224 each have distal ends pivotally attached to a slidable memberor hub 230 that is slidably attached to a support rod 232, and each haveproximal ends pivotally attached to the upper jaw 212. A distal end ofthe support rod 240 is attached to the upper jaw 212. In response to theactuation of the first and second closure cables 222 a, 222 b, the firstand second closure cables 222 a, 222 b translate longitudinally, therebycausing the hub 230 to slide either proximally (in response to theclosure cables 222 a, 222 b being pulled proximally) or distally (inresponse to the closure cables 222 a, 222 b being pushed distally).Distal movement of the hub 230 (e.g., pushing the closure cables 222 a,222 b in a distal direction) pivots the links 224 downwardly, as shownin FIGS. 6, 7, and 9, to cause the end effector 204 to open. Proximalmovement of the hub 230 (e.g., pulling the closure cables 222 a, 222 bin a proximal direction) pivots the links 224 upwardly to cause the endeffector 204 to close, as shown in FIG. 8.

As mentioned above, the tool 200 includes a cutting element 214configured to translate along the end effector 204. The cutting element214 is shown in an initial, proximal position in FIGS. 6-9. The tool 200includes a cutting element or blade cable configured to be actuated tocause translation of the cutting element 214 along the end effector 204.The cutting element cable is operatively coupled to the tool housing andis thus configured to be operatively coupled to a tool driver, via thetool housing. Input from the tool driver to the tool housing can thus beconfigured to actuate the cutting element cable to cause movement of thecutting element cable 214 to cause the translation of the cuttingelement 214 and hence cause the cutting of tissue engaged between thejaws 210, 212.

The tool 200 includes an energy or electrical cable configured toprovide energy to the electrodes 210 e, 212 e at the end effector 204.The energy cable is operatively coupled to the tool housing and is thusconfigured to be operatively coupled to a tool driver, via the toolhousing. Input from the tool driver to the tool housing can thus beconfigured to actuate the energy cable to selectively cause energy to bedelivered to electrodes 210 e, 212 e.

The tool 200 includes at least one electrical wire for each of theelectrodes 210 e, 212 e that can receive energy from the energy cableand deliver the energy to the electrodes 210 e, 212 e. As shown in FIGS.6, 7, and 8A, the tool 200 has two electrical wires 210 w for theelectrode 210 e at the bottom jaw 210. These bottom wires 210 w extendlongitudinally and are stationary during opening and closing of the jaws210, 212. As shown in FIGS. 7A and 8B, the tool 200 has two electricalwires 212 w for the electrode 212 e at the upper jaw 212. The upperwires 212 w move during opening and closing of the jaws 210, 212. FIG.8B shows that the upper wires 212 w have some slack S when the endeffector 204 is closed and that the upper wires 212 w lose the slack Swhen the end effector 204 is open, as shown in FIG. 7A. Having more thanone electrical wire for each of the electrodes 210 e, 212 e may be morespace efficient than having only one electrical wire for each of theelectrodes 210 e, 212 e since the multiple wires can each have a smallerdiameter than the diameter of a single wire used to provide energy to anelectrode. If, as discussed further below, wiring is contained in a heatshrink tube, larger wires, i.e., a single wire for each of theelectrodes, may be space efficient.

As shown in FIGS. 6 and 7, the closure cables 222 a, 222 b, the cuttingelement cable (omitted for clarity of illustration), and the energycable (omitted for clarity of illustration) can be disposed in andextend through a central tube 228. The tube 228 may help protect theclosure cables 222 a, 222 b, the cutting element cable, and the energycable. The cutting element cable can be substantially coaxial with thelongitudinal axis of the shaft 202, which may allow the cutting elementcable to align linearly with the slots in the end effector 204 throughwhich the cutting element 214 translates and thereby help preventbucking of the cutting element cable and/or provide straight cutting. Asshown in FIG. 7, the closure cables 222 a, 222 b can each extendsubstantially parallel to the shaft's longitudinal axis, which may helpprevent buckling of the closure cables 222 a, 222 b during longitudinalmovement thereof and/or may help the closure cables 222 a, 222 b beproperly aligned with the opposed sides of the end effector 204 withwhich they are respectively operatively coupled. The energy cable isabove the cutting element cable (as the tool 200 is illustrated in FIGS.6 and 7) in an exemplary embodiment but can be at another location.

The articulation cables 226 a, 226 b, 226 c, 226 d, the closure cables222 a, 222 b, the cutting element cable, and the energy cable areflexible at least along the wrist 206 to allow for their bending at thefirst and second joints 216, 218 at the wrist 206. The tube 228 isflexible at least along the wrist 206 to allow for its being at thewrist 206, such as by the tube 228 being formed of a flexible materialsuch as an elastomer and being relatively thin, e.g., about 0.2 mmthick.

FIG. 8 illustrates a clamping force F1 configured to be provided at adistal tip of the end effector 204 when the end effector 204 is in theclosed position. The end effector 204 can provide the clamping force F1to tissue clamped between the jaws 210, 212. For clarity ofillustration, tissue is not shown clamped between the jaws 210, 212 inFIG. 8. FIG. 8 also illustrates an actuation force F2 exerted in aproximal direction on the closure cables 222 a, 222 b to hold the endeffector 204 in the closed position. The pair of links 224 allows theactuation force F2 to be less than in other end effectors, such as endeffector using a pin of one jaw that slides in a slot of the other jawto effect jaw movement, while achieving the same clamping force F1. Forexample, a clamping force F1 for the end effector 204 can be achievedwith an actuation force F2.

FIG. 8C illustrates a side load or side force F3 at the distal tip ofthe end effector 204, such as by tissue or other matter pressing againstthe end effector 204. The articulation cables 226 a, 226 b, 226 c, 226 d(and any hypotubes holding the articulation cables 226 a, 226 b, 226 c,226 d) are configured to resist the side force F3 to help prevent theend effector 204 from articulating in response to the side force F3. Forexample, the articulation cables 226 a, 226 b, 226 c, 226 d (and anyhypotubes holding the articulation cables 226 a, 226 b, 226 c, 226 d)can be configured to resist a side force F3.

FIGS. 10 and 11 illustrate another embodiment of a surgical toolconfigured to apply energy to tissue. The tool of FIGS. 10 and 11 isconfigured and used similar to the tool 200 of FIGS. 6-9 except that ithas a different closure mechanism than the tool 200. In the tool 200 ofFIG. 6-9, the closure mechanism configured to open and close the endeffector 204 includes the links 224, the slidable member 230, and theclosure cables 222 a, 222 b. In the tool of FIGS. 10 and 11, the closuremechanism includes a pair of pins 300 (one of the pins 300 is obscuredin FIGS. 10 and 11), a slidable member 302, and first and second closurecables (obscured in FIGS. 10 and 11). The closure mechanism in theillustrated embodiment of FIGS. 10 and 11 does not include links, whichmay facilitate assembly of the tool. Instead, the tool's upper jaw 304has a pair of slots 306 formed therein (one of the slots 306 is obscuredin FIGS. 10 and 11) that has the pins 300 slidably received therein. Thepins 300 extend laterally outward from the slidable member 302, which isslidably attached to a support rod 308. In response to the actuation ofthe first and second closure cables, the first and second closure cablestranslate longitudinally, thereby causing the hub 302 to slide eitherproximally (in response to the closure cables being pulled proximally)or distally (in response to the closure cables being pushed distally).Distal movement of the hub 302 (e.g., pushing the closure cables in adistal direction) causes the pins 300 to slide upwardly in the slots306, as shown in FIG. 10, to cause the tool's end effector 310 to open.Proximal movement of the hub 302 (e.g., pulling the closure cables in aproximal direction) causes the pins 300 to slide downwardly in the slots306 to cause the end effector 310 to close, as shown in FIG. 11.

FIGS. 12-14 illustrate another embodiment of a surgical tool configuredto apply energy to tissue. The tool of FIGS. 12-14 is configured andused similar to the tool 200 of FIGS. 6-9 except that it has a differentclosure mechanism than the tool 200. In the tool of FIG. 12-14, theclosure mechanism configured to open and close the tool's end effector400 includes a link 402, a slidable member 404, first and second closurecables 406 a, 406 b, and a pulley 408. A distal end of the link 402 ispivotally attached to the tool's upper jaw 410, and a proximal end ofthe link 402 is pivotally attached to the slidable member 404. Theslidable member 404 is slidably attached to a support rod 412. FIGS. 12and 14 show the end effector 400 in the open position, and FIG. 13 showsthe end effector 400 in the closed position.

The first closure cable 406 a is operatively coupled to the pulley 408,with the first closure cable 406 a being looped around the pulley 408with trailing ends of the closure cable 406 a extending proximally fromthe pulley 408. The pulley 408 is located distal to the slidable member404. A distal end of the first closure cable 406 a is attached to adistal end of the slidable member 404. The tool also includes a secondpulley 408 a that is located proximal to the slidable member 404. Thesecond pulley 408 a is configured to help smoothly guide the firstclosure cable 406 a into the tool's elongate shaft (not shown in FIGS.12-14 for clarity of illustration). A proximal end of the first closurecable 406 a is at the tool's tool housing and is operatively coupled toone of the tool housing's input interfaces. A distal end of the secondclosure cable 406 b is attached to a proximal end of the slidable member404. A proximal end of the second closure cable 406 b is at the tool'stool housing and is operatively coupled to one of the tool housing'sinput interfaces. The first and second closure cables 406 a, 406 b canthus be actuated via an input from a robotic surgical system provided tothe input interfaces to which the first closure cables 406 a, 406 b arerespectively operatively coupled, e.g., an input causing the inputinterfaces to rotate and thereby cause longitudinal translation of theirrespective closure cables 406 a, 406 b.

In response to the actuation of the first and second closure cables 406a, 406 b, the first and second closure cables 406 translatelongitudinally, thereby causing the hub 404 to slide either proximally(in response to the second closure cable 406 b being pulled proximally)to close the end effector 400 or distally (in response to the firstclosure cable 406 a being pulled proximally and sliding around thepulley 408) to open the end effector 400. Since both of the closurecables 406 a, 406 b are attached to the hub 404, when the second closurecable 406 b is pulled proximally the first closure cable 406 a is pusheddistally, and when the first closure cable 406 a is pulled proximallythe second closure cable 406 b is pushed distally. In other words, thefirst and second closure cables 406 a, 406 b are configured tosimultaneously move in opposite directions to effect opening/closing ofthe end effector 400. The input interfaces to which the first and secondclosure cables 406 a, 406 b are respectively operatively coupled aretherefore configured to work in cooperation with one another, with oneof the inputs to the input interfaces pulling and “winding up” one ofthe cables 406 a, 406 b and the other of the inputs to the inputinterfaces pushing and “letting out” the other of the cables 406 a, 406b at a force substantially equal to the pulling force. A person skilledin the art will appreciate that the pushing and pulling forces may notbe precisely equal but nevertheless be considered to be substantiallyequal due to any number of factors, such as manufacturing tolerance andprecision of measurement devices. Independent movement of the first andsecond closure cables 406 a, 406 b to effect end effectoropening/closing may accommodate different forces needed for each closurecable 406 a, 406 b due to the closure cables 406 a, 406 b being flexeddifferent amounts depending on an articulation angle of the end effector400 and/or due to the closure cables 406 a, 406 b experiencing differentwear over time such that one of the closure cables 406 a, 406 b becomesmore slack over time than the other of the closure cables 406 a, 406 b.The pulling forces to cause end effector opening and closing are lessfor the tool of FIGS. 12-14 than for the tool 200 of FIGS. 6-9 and thetool of FIGS. 10 and 11, which may provide for more precise control ofend effector opening/closing. Each of the closure cables 406 a, 406 bare attached to the hub 404 in an upper half of the tool's wrist 414,which may help balance the antagonistic or opposite forces appliedthereto and cause smooth movement of the link 402 during end effector400 opening/closing.

In another embodiment, a surgical tool can be configured and usedsimilar to the tool of FIGS. 12-14 except that the tool can include asecond link in addition to the link 402, similar to the surgical toolsdiscussed above that include a pair of links.

FIG. 15 illustrates another embodiment of a surgical tool configured toapply energy to tissue. The tool of FIG. 15 is configured and usedsimilar to the tool of FIGS. 12-14 except that it has its pulley 416 forits first closure cable 418 a at a different orientation at the tool'swrist 420 than the tool of FIGS. 12-14. The tool of FIG. 15 also has apair of links 422, as opposed to the tool of FIGS. 12-14 that only hasone link 402. In the tool of FIGS. 12-14, the pulley 408 for the firstclosure cable 406 a is in a vertical orientation such that trailing endsof the first closure cable 406 a are vertically arranged, e.g., one ofthe trailing ends is above the other of the trailing ends. In the toolof FIG. 15, the pulley 416 is in a horizontal orientation such thattrailing ends of the first closure cable 418 a are horizontallyarranged, e.g., the trailing ends are laterally spaced apart from oneanother. The horizontal orientation of the pulley 416 may free morespace at the tool's wrist 420 for the tool's articulation cables, energycable, and ground cable.

FIGS. 16-18 illustrate another embodiment of a surgical tool configuredto apply energy to tissue. The tool of FIGS. 16-18 is configured andused similar to the tool of FIGS. 12-14 except that it has its pulley426 for its first closure cable 428 a at a different orientation at thetool's wrist 430 than the tool of FIGS. 12-14 and than the tool of FIG.15. The tool of FIGS. 16-18 also has a pair of links 432, as opposed tothe tool of FIGS. 12-14 that only has one link 402. In the tool of FIGS.16-18, the pulley 426 is at an angled orientation such that trailingends of the first closure cable 428 a are angularly offset from oneanother, e.g., the trailing ends are laterally spaced apart from oneanother and are vertically offset from one another. The pulley 426 is atabout a 45° angle in this illustrated embodiment, but the pulley 426 canbe angularly offset at another angle. A person skilled in the art willappreciate that the angle may not be precisely at a value, e.g.,precisely at 45°, but nevertheless be considered to be substantiallyabout that value due to any number of factors, such as manufacturingtolerance and precision of measurement devices. The angled orientationof the pulley 426 may allow for the pulley 426 to have a smallerdiameter (e.g., about 3 mm outer diameter) than if the pulley werearranged horizontally, e.g., as in the embodiment of FIG. 15, orarranged vertically, e.g., as in the embodiment of FIGS. 12-14. Sincereal estate at the wrist 430 is limited, smaller components at the wrist430 may help accommodate all necessary components. The angledorientation of the pulley 426 still allows for the first closure cable426 a to be close to a central longitudinal axis 434 of the tool'selongate shaft 466 (see FIG. 19), similar to the embodiments of FIGS.12-14 and FIG. 15. The first closure cable 426 a and second closurecable 426 b each being as close to the central longitudinal axis 434 aspossible may help prevent off-axis motion of the tool's end effector 436and/or limit the need to adjust for different closure cable lengths asthe closure cables 426 a, 426 b as farther away radially from thecentral longitudinal axis 434.

As mentioned above, a distal end of a cable can be enlarged tofacilitate attachment thereof to another component. FIG. 18 illustratesan enlarged distal end 429 of the second closure cable 428 b thatfacilitates attachment of the second closure cable 428 b to the tool'sslidable member 438. As also shown in FIG. 18, the slidable member 438is slidably attached to a support rod 440.

As shown in FIG. 17, the tool includes three linkages 442, 444, 446 atthe wrist 430. Similar to that discussed above regarding the linkage 208of FIGS. 6-9, the linkages 442, 444, 446 are configured to facilitatearticulation of the end effector 436 relative to the elongate shaft 466.A distal end of the first linkage 442 is non-pivotally coupled to aproximal end of the end effector 436, e.g., to a proximal end of the endeffector's bottom jaw 448. A proximal end of the first linkage 442 ispivotally coupled at a first or distal joint 450 to a distal end of thesecond linkage 444. A proximal end of the second linkage 444 ispivotally coupled at a second or proximal joint 452 to a distal end ofthe third linkage 446. A proximal end of the third linkage 446 isnon-pivotally coupled a distal end of the elongate shaft 466.

The first joint 450 defines a first pivot axis P3 about which the firstlinkage 442, and hence the end effector non-pivotally coupled thereto,is configured to pivot relative to the second linkage 444 in pitchmotion. The first joint 450 thus defines a first plane in which thefirst linkage 442, and hence the end effector, is configured to moverelative to the elongate shaft 466 to adjust the end effector's pitchrelative to the elongate shaft 466. The second joint 452 defines asecond pivot axis P4 about which the second linkage 444 is configured topivot relative to the third linkage 446, and hence to the elongate shaft466 non-pivotally coupled to the third linkage 446, in yaw motion. Thesecond joint 452 thus defines a second plane in which the second linkage444 is configured to move relative to the third linkage 446, and hencethe elongate shaft 466, to adjust the end effector's yaw relative to theelongate shaft 466. The end effector 436 is in an unarticulated positionin FIGS. 16-18.

As shown in FIGS. 17 and 20-22, the tool in this illustrated embodimentincludes four articulation cables 454 (the articulation cable in thelower left is obscured in FIG. 17 but is visible in FIGS. 20-22)configured to facilitate articulation of the end effector 436, a cuttingelement cable 456 configured to facilitate movement of the tool'scutting element (obscured in FIGS. 16-18), an energy cable 458configured to facilitate delivery of energy to electrodes 460 coupled tothe upper and lower jaws 462, 448, and a ground cable 464. FIGS. 19-22illustrate the positions of the closure cables 428 a, 428 b, thearticulation cables 454, the cutting element cable 456, the energy cable458, and the ground cable 464 at four positions N1, N2, N3, N4longitudinally along the tool. The fourth position N4 is at a proximalend of the elongate shaft 466. The articulation cables 454, energy cable458, and ground cable 464 are at the same location in all of the fourpositions N1, N2, N3, N4, e.g., are at a same distance radially from thecentral longitudinal axis 434 and at a same relative distance from eachother. In the first position N1, as shown in FIG. 20, the first andsecond closure cables 428 a, 428 b are at a lateral or horizontaldistance D1 from each other, e.g., about 9 mm, and are at a verticaldistance D2, e.g., about 1.4 mm, from the central longitudinal axis 434,along which the cutting element cable 456 extends. In the second andthird positions N2, N3, as shown in FIG. 21, the horizontal distance D1is the same as in the first position N1, and the vertical distance D2has decreased from the third position N3, e.g., decreased from about 1.4mm to about 0.9 mm. In the fourth position N4, as shown in FIG. 22, thehorizontal distance D1 has increased from the third position N3, e.g.,increased from 0.9 mm to about 4.0 mm, and the vertical distance D2 hasdecreased from the third position N3, e.g., decreased from about 0.9 mmto about 0.3 mm. The relative positions of the first and second closurecables 428 a, 428 b being different at different positionslongitudinally along the tool may reflect the first closure cable'sangled extension from the pulley 426 and/or may help facilitatepackaging and/or layout.

FIGS. 23-25 illustrate one embodiment of a tool housing 468 that can becoupled to a proximal end of the elongate shaft 466. The tool housing468 has six input interfaces 470, 472, 474, 476, 478, 480 eachconfigured to receive an input from a robotic surgical system (e.g., atool driver thereof) coupled to the tool housing 468. The inputinterfaces 470, 472, 474, 476, 478, 480 are rotary inputs in thisillustrated embodiment, e.g., each are configured to rotate to effect afunction of the tool. As shown in FIG. 23, the first and second closurecables 428 a, 428 b, the articulation cables 454, and the cuttingelement cable 456 are operatively coupled to their respective inputinterfaces with plastic interfaces to facilitate electrical isolation.The first and second articulation cables 464 are attached to a firstplastic capstan 470 a, the third and fourth articulation cables 464 areattached to a second plastic capstan 472 a, the first closure cable 426a is attached to a third plastic capstan 474 a, the cutting elementcable 456 is attached to a fourth plastic capstan 476 a, and the secondclosure cable 426 b is attached to a fifth plastic capstan 480 a. Theenergy cable 458 and the ground cable 464 extend proximally from thehousing 468 to connect to a generator (not shown).

The first input interface 470 is configured to receive an input from therobotic surgical system to drive two of the tool's four articulationcables 464 to facilitate articulation of the end effector 436. Thesecond input interface 472 is configured to receive an input from therobotic surgical system to drive the other two of the tool's fourarticulation cables 464 to facilitate articulation of the end effector436. The articulation cables 464 can be pre-tensioned at assembly attheir respective input interfaces 470, 472, which may help ensureaccuracy and stability. As shown in FIG. 25, the first and second inputinterfaces 470, 472 include the first and second capstans or winches 470a, 472 b, respectively, that operatively engages the pair ofarticulation cables 464 associated therewith, e.g., terminal ends of thearticulation cables 464 are attached to their respective winches 470 b,472 b. The first winch 470 a is also shown in FIGS. 26 and 27. The firstinput interface 470 is configured to receive an input from a first motorof the tool driver that operatively couples to the tool housing 468 thatdrives rotation of the first winch 470 a to thereby drive longitudinalmovement of the pair of articulation cables 464 operatively coupled tothe first input interface 470. The input to the first input interface470 can thus be a rotational input. Similarly, the second inputinterface 472 is configured to receive an input from a second motor ofthe tool driver that operatively couples to the tool housing 468 thatdrives rotation of the second winch 472 a to thereby drive longitudinalmovement of the pair of articulation cables 464 operatively coupled tothe second input interface 472. The input to the second input interface472 can thus be a rotational input. Each of the winches 470 a, 472 a canbe operatively coupled to first and second bias members 470 c, 472 c,which in this illustrated embodiment include torsion springs coiledaround their respective winches 470 a, 472 a. The bias members 470 c,472 c are configured to bias the end effector 436 to an unarticulatedposition by biasing their respective winches 470 b, 472 to hold theirrespective pair of articulation cables 464 at a tension that keeps theend effector 436 unarticulated. The end effector 436 can thus be biasedto the unarticulated position, via the bias members 470 c, 472 c, evenwhen the tool is not coupled to a robotic surgical system. The endeffector 436 being biased to the unarticulated position may facilitateremoval of the tool from a trocar or other access device.

The tool housing 468 in this illustrated embodiment includes a routingand support member 482 configured to route the articulation cables 464therethrough to their associated one of the first and second inputinterfaces 470, 472. The routing and support member 482 is alsoconfigured to support a rod 484 operatively coupled to the cuttingelement cable 456.

The third input interface 474 and the sixth input interface 480 are eachconfigured to receive an input from the robotic surgical system to driveselective end effector 436 opening and closing. The input to the thirdinput interface 474 is configured to cause rotation of the third capstan474 a that is operatively engaged with the first closure cable 428 a.The input to the third input interface 474 can thus be a rotationalinput. The rotation of the third capstan 474 a is configured to causelongitudinal translation of the first closure cable 428 a. Similarly,the input to the sixth input interface 480 is configured to causerotation of the sixth capstan 480 a that is operatively engaged with thesecond closure cable 428 b. The input to the sixth input interface 480can thus be a rotational input. The rotation of the sixth capstan 480 ais configured to cause longitudinal translation of the second closurecable 428 b. As discussed above, the first closure cable 428 a beingpulled proximally and the second closure cable 428 b being pusheddistally will cause the end effector 436 to open, and the first closurecable 428 a being pushed distally and the second closure cable 428 bbeing pulled proximally will cause the end effector 436 to close. Inother words, for end effector 436 opening the third motor operativelycoupled to the third input interface 474 can be the driving motor andthe sixth motor operatively coupled to the sixth motor interface 480 canbe the follower motor, and for end effector 436 closing the third motoroperatively coupled to the third input interface 474 can be the followermotor and the sixth motor operatively coupled to the sixth motorinterface 480 can be the driving motor.

Each of the third and sixth winches 474 a, 480 a can be operativelycoupled to first and second bias members 480 c (the first bias membercoupled to the third winch 474 a is obscured in the figures), which inthis illustrated embodiment include torsion springs coiled around theirrespective winches 474 a, 480 a. The first and second bias members 480 care configured to bias the end effector 436 to a closed position bybiasing their respective winches 474 a, 480 a to hold their respectiveclosure cables 428 a, 428 b at a tension that keeps the end effector 436closed. The end effector 436 can thus be biased closed, via the firstand second bias members 480 c, even when the tool is not coupled to arobotic surgical system. The end effector 436 being biased to the closedposition may facilitate removal of the tool from a trocar or otheraccess device.

The tool housing 468 includes a manual override knob 486 configured toallow for manual opening and closing of the end effector 436. The manualoverride knob 486 is accessible from outside the tool housing 468, e.g.,accessible to be manually moved by hand from outside the tool housing468. The manual override knob 486 may allow end effector 436opening/closing in the unlikely event of power failure that prevents endeffector 436 opening/closing via input to the third and sixth inputinterfaces 474, 480. Rotating the manual override knob 486 in onedirection will cause the end effector 436 to open by rotating acorresponding gear 488 coupled to the third winch 474 a, and rotatingthe manual override knob 486 in the other direction will cause the endeffector 436 to close by rotating the corresponding gear 488 coupled tothe third winch 474 a. The manual override knob 486 can have otherconfigurations, such as levers, actuators, arms, and triggers, to rotatethe corresponding gear 488 and cause manual override.

The fourth input interface 476 is configured to receive an input fromthe robotic surgical system to drive cutting element translation via arack and pinion system that is operatively coupled to the cuttingelement cable 456. The input to the fourth input interface 476 isconfigured to cause rotation of a pinion 490 that is operatively engagedwith a rack 492, which is operatively coupled to the rod 484. The inputto the fourth input interface 476 can thus be a rotational input. Therack 492 is operatively coupled with the cutting element cable 436 viathe rod 484 such that the translational movement of the rack 492 causescorresponding translational movement of the cutting element cable 436,thereby causing selective translation of the cutting element proximally(proximal translation of the rack 492, and rotation of the pinion 490 inone direction) or distally (distal translation of the rack 492, androtation of the pinion 490 in an opposite direction).

The tool housing 468 includes a bias element 494 configured to bias thecutting element to a distal position, which may help prevent the cuttingelement from accidentally cutting tissue and/or other material betweenthe jaws of the end effector 436. The bias element 494 in thisillustrated embodiment is a spring coiled around the rod 484. A distalend of the bias element 494 abuts a second routing and support member498, and a proximal end of the bias element abut an extension of therack 292. The second routing and support member 498 is configured toroute the closure cables 428 a, 428 b therethrough to their respectiveinput interfaces 474, 480, to route the cutting element cable 456 to thefourth input interface 476, and to support the rod 484.

The fifth input interface 478 is configured to receive an input from therobotic surgical system to drive rotation of the elongate shaft 466 viaa gear system. The input to the fifth input interface 478 is configuredto cause rotation of a first gear 478 a. The input to the fifth inputinterface 478 can thus be a rotational input. The rotation of the firstgear 478 a is configured to rotate a second gear 478 b operativelyengaged therewith. The second gear 478 b is operatively coupled to theshaft 466 such that rotation of the second gear 478 b rotates theelongate shaft 466 (and the end effector 436 at the distal end thereof).The tool housing includes a stop member 496 configured to preventrotation of the shaft 466 beyond about 540°, e.g., is configured toallow free rotation of the shaft 466 up to about 540°.

FIG. 28 illustrates another embodiment of a tool housing 700 that can becoupled to a proximal end of an elongate shaft of a surgical toolconfigured to apply energy to tissue. In this illustrated embodiment,first and second bias members 702, 704, which are in the form ofconstant force springs, are configured to bias the tool's end effector(not shown) to an unarticulated position by holding their respectiveassociated pair of articulation cables (not shown) at a tension thatkeeps the end effector unarticulated. The bias members 702, 704 aregenerally configured and used similar to the first and second biasmembers 470 c, 472 c discussed above. FIG. 28 illustrates a distaldirection R1 of the force applied by the bias members 702, 704 and aproximal direction R2 of the force applied to push the articulationcables. As shown, the bias members 702, 704 are located at a distal endof the tool housing 700, which allows the bias members 702, 704 toprovide forces in the appropriate direction without the need for anypulleys to redirect the forces. FIG. 28 also illustrates a rack andpinion system 706 configured to effect movement of the articulationcables, similar to the rack and pinion system discussed above. The toolhousing 700 can include other features to effect other functions,similar to the tool housings discussed above, e.g., shaft rotation, endeffector opening/closing, etc. In at least some embodiments, the toolhousing can include an amplification mechanism (e.g., a lever, etc.)configured to amplify a weaker bias member up to the required force.

In an alternate embodiment, first and second bias members can be locatedat a proximal end of the tool housing with a pulley included for each ofthe bias members to redirect their forces in the appropriate distaldirection R1. The bias members being located at the tool housing'sproximal end may allow for the bias members to be larger and providemore force. FIG. 29 illustrates one embodiment of a tool housing withproximally located bias members, although only one of the bias members708 and its associated pulley 710 is shown for clarity of illustration.For example, a force F4 can be provided by the tool's actuator 712,e.g., the tool's input interface, and the bias member 708 can beconfigured to provide a force F5 in the opposite direction of the forceF4, with an effective force F6 on the bias member's associatedarticulation cable 714 in both directions. About 10 mm of articulationcable travel can be needed to fully articulate the tool's end effector716.

FIG. 30 illustrates another embodiment of a tool housing 800 that can becoupled to a proximal end of an elongate shaft of a surgical toolconfigured to apply energy to tissue. In this illustrated embodiment,the tool housing 800 has an extended proximal portion 802 configured tohouse therein bias members associated with various input interfaces ofthe tool housing 800, as discussed further below. In this illustratedembodiment, the tool housing 800 has six input interfaces with first andsecond input interfaces for articulation of the tool's end effector, athird input interface for end effector opening/closing, a fourth inputinterface for cutting element translation, a fifth input interface forrotation of the tool's elongate shaft, and a sixth input interface isavailable for other use. In this illustrated embodiment, the first andsecond input interfaces are rotary mechanisms, and the third, fourth,fifth, and sixth input interfaces are linear mechanisms.

As shown in FIGS. 30-32, the first input interface for articulationincludes a first articulation mechanism 804, and the second inputinterface for articulation includes a second articulation mechanism 806.The first articulation mechanism 804 includes a rack and pinion system808 configured to effect articulation cable movement of a first pairarticulation cables 810, similar to the rack and pinion system discussedabove. The first articulation mechanism 804 also includes a pair of biasmembers 812, which is in the form of constant force springs in thisillustrated embodiment. The second articulation mechanism 806 includes agear system 814 configured to effect articulation cable movement of asecond pair of articulation cables 816 via gear rotation that causeslongitudinal translation of a translation member 818 biased with a biasmember 820, which is in the form of a coil spring in this illustratedembodiment. Sensitivity of the second articulation mechanism 806 can beadjusted by changing the gearing and lead screw pitch. The first andsecond articulation mechanisms 804, 806 can each be configured, forexample, to provide about 10 mm of translational articulation cablemovement, which can be enough to cause full articulation of the endeffector (e.g., +/− about 160°) and to resist a side load at the endeffector's distal tip. FIGS. 31 and 32 also show hypotubes 810 h, 816 hcontaining distal portions of the articulation cables 810, 816.

As shown in FIGS. 30 and 34, the third input interface can include aclosure mechanism 822 that includes a rack and pinion system 824configured to effect end effector opening/closing, similar to the rackand pinion system discussed above. The closure mechanism 822 alsoincludes a bias element 826, which is in the form of a constant forcespring in this illustrated embodiment, and a pulley 828 to direct motionin the appropriate distal direction. The closure mechanism 822 can beconfigured, for example, to provide about 5 mm of translational closurecable 828 movement to fully open/close the end effector (e.g., with theend effector's jaws at an angle of about 30°) and enough force toachieve clamping force at the end effector's distal tip. One inputinterface is used for end effector opening/closing in this illustratedembodiment since it may provide enough force to achieve the clampingforce at the end effector's distal tip to effectively clamp tissuebetween the end effector's jaws. FIG. 34 also shows a hypotube 830 hcontaining a distal portion of the closure cable 830.

As shown in FIGS. 30 and 33, the fourth input interface can include acutting element translation mechanism 832 that includes a translationalmember 834 configured to longitudinally translate to effect longitudinaltranslational movement of the cutting element cable 836. The cuttingelement translation mechanism 832 also includes a bias element 838,which is in the form of a constant force spring in this illustratedembodiment, and a pulley 840 to direct motion in the appropriate distaldirection. The cutting element translation mechanism 832 can beconfigured, for example, to provide about 24 mm of cutting elementtranslational movement to fully translate the cutting element fullyalong the end effector and enough force to overcome friction when theend effector is fully articulated.

FIGS. 35-37 illustrate another embodiment of a surgical tool configuredto apply energy to tissue. The tool of FIGS. 35-37 is generallyconfigured and used similar to the tool of FIGS. 16-18. In thisillustrated embodiment, the tool includes four articulation cables 500arranged radially around a central longitudinal axis 502, a cuttingelement cable 504 extending substantially along the central longitudinalaxis 502, and a jaw closure tube 506 coaxially arranged around thecutting element cable 504. The tool of FIGS. 35-37 thus does not includeany closure cables, instead being configured to open and close jaws ofits end effector via translational movement of the jaw closure tube 506.The cutting element cable 504 and the jaw closure tube 506 areconfigured to be actuated via push/pull motion (e.g., push/pull thecutting element cable 504 to cause cutting element movement, andpush/pull the jaw closure tube 506 to cause jaw opening/closing) and tobe freely slidable throughout the end effector's range of articulation,including when the tool's end effector is fully articulated, withoutbuckling. The cutting element cable 504 and the jaw closure tube 506 arearranged around the central longitudinal axis 502 such that theirrespective actuation forces will be directed along the tool'scenterline, which may help prevent the buckling and/or allow for evenforce distribution.

As shown in FIGS. 36 and 37, bending radii may be maximized with thecable arrangement of this illustrated embodiment. FIG. 36 shows adiameter 506 d, e.g., about 0.95 mm, of the jaw closure tube 206, adiameter 504 d, e.g., about 0.58 mm, of the cutting element cable 504,and a diameter 508 d, e.g., about 5.4 mm, of a third linkage 508. Thetool also has first and second linkages 510, 512. FIG. 36 also shows ahypotube 514 around the jaw closure tube 506 and the cutting elementcable 504. The hypotube 514 has a diameter 514 d of, e.g., about 2.0 mm.FIG. 36 also shows a bending radius 504 b of the cutting element cable504, e.g., about 5.1 mm, and a bending radius 514 b of the hypotube 514,e.g., about 4.1 mm. The bending radii 504 b, 514 b can be increased byopening up a wall 508 w of the third linkage 508. The hypotube 514, andhence also the jaw closure tube 506 and cutting element cable 504contained therein, is configured to shift off the central longitudinalaxis 502 to allow for more generous radii 504 b, 514 b.

To facilitate bending of the jaw closure tube 506 and cutting elementcable 504 when the end effector is articulated, the hypotube 514 caninclude a plurality of cuts therein, such as by being laser cut therein.FIG. 38 illustrates one embodiment of the hypotube 514 including aplurality of cuts 516 therein that are in a spiral pattern with a pitchof about 0.35 mm. FIG. 39 illustrates another embodiment of the hypotube514 including a plurality of cuts 518 therein that are in a spiralpattern with a pitch of about 0.20 mm. As pitch of the cuts decrease,the bending radius 514 b of the hypotube 514 increases and the segmentsof the hypotube 514 between cuts is thinner and weaker. FIG. 40illustrates another embodiment of the hypotube 514 including a pluralityof cuts 520 therein that are in a trapezoidal pattern. In thetrapezoidal pattern, each kerf cut refers to a full circumferential cutwith alternate trapezoidal orientations, thereby resulting in individualsegments that are interlocked axially. Increasing the number of kerfcuts in the pattern results in a smaller bend radius. A hypotube with atrapezoidal pattern of cuts is able to support a higher axial load thana hypotube with a spiral pattern of cuts.

FIG. 41 illustrates another embodiment of a surgical tool configured toapply energy to tissue. The tool of FIG. 41 is generally configured andused similar to the tool of FIGS. 16-18. In this illustrated embodiment,the tool includes four articulation cables 522 arranged radially arounda central longitudinal axis 524, a cutting element cable 526 extendingsubstantially parallel to and below the central longitudinal axis 524,and a closure cable 528 extending substantially parallel to and abovethe central longitudinal axis 524. The off-center position of theclosure cable 528 creates a moment or force at the tool's wrist joints.The articulation cables 522 are configured to resist the moment orforce.

FIG. 42 illustrates another embodiment of a surgical tool configured toapply energy to tissue. The tool of FIG. 42 is generally configured andused similar to the tool of FIGS. 16-18. In this illustrated embodiment,the tool includes a closure cable 530, a cutting element cable 532, anenergy cable 534, and a ground cable 536 that are each disposed in andextend through a tube 538. The tube 538 may help protect the closurecable 530, the cutting element cable 532, the energy cable 534, and theground cable 536. The closure cable 530 and the cutting element cable532 are also each contained in polymide braided tubing 538, 540, whichmay also help protect their respective cables 530, 532. Initially, asshown in FIG. 42, the tube 538 can be heat shrinked around the closurecable 530, cutting element cable 532, energy cable 534, and ground cable536. The heat shrinking of the tube 538 can cause the closure cable 530,cutting element cable 532, energy cable 534, and ground cable 536 toabut one another, as shown in FIG. 42. In the heat shrinked tube 538,the closure cable 530, cutting element cable 532, energy cable 534, andground cable 536 are each offset from the central longitudinal axis andare arranged therearound. The tube heat shrinked 538 can be fit to thetool, and energy cable 534 and ground cable 536 can be moved outwardfrom their position in FIG. 42 while the cutting element cable 532slides therebetween to extend substantially along the centrallongitudinal axis. This movement of the cables 532, 534, 536, andmovement of the closure cable 530 that may also occur during thistransition, may be gentle enough that it can occur with minimal impacton the cables.

In at least some embodiments of a surgical tool configured to applyenergy to tissue, as discussed herein, a cutting element cable isattached to a cutting element, e.g., via welding, crimping, etc., toeffect translational movement of the cutting element along an endeffector of the tool. As shown in one embodiment of such a surgical toolillustrated in FIG. 43, a cutting element cable 600 is attached to acutting element 602 that translates along the tool's end effector 604,which includes upper and lower jaws 606, 608. Each of the upper andlower jaws 606, 608 has a longitudinal slot 606 s, 608 s formed thereinthrough which the cutting element 602 translates. Each of the upper andlower jaws 606, 608 also has an electrode 606 e, 608 e on a tissueengaging surface thereof. Edges 606 d, 608 d of pads 606 p, 608 p of theelectrodes 606 e, 608 e are chamfered on each side of the cuttingelement 602, as shown in FIG. 43, to cradle the cutting element cable600 during the translation of the cutting element 600, since the cuttingelement cable 600 is wider than the cutting element 602, as also shownin FIG. 43.

In at least some embodiments of a surgical tool configured to applyenergy to tissue, as discussed herein, an end effector includes one ormore spacers configured to ensure that a gap of space exists between thetissue contacting surfaces of the end effector's upper and lower jaws,which may help prevent shorting of electrodes on the tissue contactingsurfaces. As shown in FIGS. 43-44A, one embodiment of such an endeffector 604 includes a single spacer 610 at a distal end of alongitudinal slot 612 through which the cutting element 602 translatesalong the end effector 604. The cutting element 604 thus does not passany spacers during its longitudinal translation along the end effector604 while moving in the slot 612 and cutting tissue engaged by the jaws606, 608, which may prevent the cutting element 602 and the cuttingelement cable 600, which is wider than the cutting element 602, fromcatching on the attachment point(s), e.g., weld point(s) between thecutting element 602 and the cutting element cable 600. The spacer 610 ison the lower jaw 608 and extends toward the upper jaw 606 in thisillustrated embodiment, but the spacer can instead be on the upper jaw606 and extend toward the lower jaw 608.

FIG. 45 illustrates another embodiment of a surgical tool 614 configuredto apply energy to tissue. The tool 614 is generally configured and usedsimilar to the tool 200 of FIGS. 6-9, e.g., includes an elongate shaft616, an end effector 618 including upper and lower jaws 620, 622, awrist 624 that couples the end effector 618 to the shaft 616 at a distalend of the shaft 616, a linkage 634 that couples the end effector 618and shaft 616 together, a tool housing (not shown) coupled to a proximalend of the shaft 616, a cutting element 620 that translates along theend effector 618, four articulation cables 622, two closure cables, acentral tube 624, a pair of links 626 (one of the links is obscured inFIG. 45), an energy cable, a pair of electrical wires 628 for each ofthe tool's electrodes 630 a, 630 b, and a cutting element cable 632.

In this illustrated embodiment, the cutting element cable 632 isoperatively coupled to a pulley 636 at the end effector 618 to effecttranslational movement of the cutting element 620 along the end effector618. One of the trailing ends of the cutting element cable 632 extendsproximally from one side of the pulley 636, and the other of the cuttingelement cable's trailing ends extends proximally from the other side ofthe pulley 636. Pulling a first one of the cutting element cable'strailing ends proximally, e.g., via input to an input interface at thetool housing, is configured to translate the cutting element 620distally along the end effector 618, e.g., to cause cutting of tissueengaged by the end effector 618, with the cutting element cable 632sliding along the pulley 636. When the cutting element 620 is at itsdistal-most position along the end effector 618, pulling of the firstone of the trailing ends of the cutting element cable 632 will not causemovement of the cutting element 620. Pulling the other one of thecutting element cable's trailing ends proximally, e.g., via input to aninput interface at the tool housing, is configured to translate thecutting element 620 proximally along the end effector 618, e.g., toretract the cutting element 620, with the cutting element cable 632sliding along the pulley 636. When the cutting element 620 is at itsproximal-most position along the end effector 618, as shown in FIG. 45,pulling of the second one of the trailing ends of the cutting elementcable 632 will not cause movement of the cutting element 620. When theend effector 618 is articulated at one or both of the tool's joints 638,640, the cutting element cable 632 being pulled proximally to actuatethe cutting element 620 more easily bends or flexes the cutting elementcable 632 at the pivoted one or both of the joints 638, 640, as comparedto the cutting element cable 632 being pushed distally. The cuttingelement cable 632 may thus not be subjected to buckling loads, therebyreducing chances of cable failure and/or increasing an overall life ofthe cable 632. Including the pulley 636 in the end effector 600, e.g.,in the lower jaw 622 as shown, does not add any dead space in the endeffector 618.

FIGS. 46-50 illustrate another embodiment of a surgical tool configuredto apply energy to tissue. The tool is generally configured and usedsimilar to the tool 10 of FIG. 1, e.g., includes an elongate shaft 900,an end effector 902, a wrist 904 that couples the end effector 902 tothe shaft at a distal end of the shaft, and a tool housing 906 coupledto a proximal end of the shaft 900. The end effector 902 in thisillustrated embodiment includes opposed lower and upper jaws 908, 910that each include an electrode 908 e, 910 e on tissue-facing surfacesthereof. Similar to the tool 200 of FIGS. 6-9, the wrist 904 of the toolincludes a linkage 912 configured to facilitate articulation of the endeffector 902 relative to the elongate shaft 900 about first and secondpivot axes P5, P6.

The tool includes four articulation and closure cables 914 a, 914 b, 914c, 914 d, with a first pair of articulation and closure cables 914 a,914 b on one side of the tool and a second pair of articulation andclosure cables 914 c, 914 d on the opposite side of the tool. Distalends of the first and second articulation and closure cables 914 a, 914b are attached to a first pulley 916 a (see FIG. 47) at a distal end ofthe end effector 902, and distal ends of the third and fourtharticulation and closure cables 914 c, 914 d are attached to a secondpulley (obscured in FIG. 47) at the distal end of the end effector 902.The articulation cables 914 a, 914 b, 914 c, 914 d are configured to beselectively actuated (e.g., pushed/pulled in response to inputs to inputinterfaces at the tool housing 906) to cause pivoting motion at one orboth of the first and second pivot axes P5, P6 or opening/closing of thejaws 908, 910. The same cables 914 a, 914 b, 914 c, 914 d are thusconfigured to effect both articulation and closing/opening of the endeffector 902, which may help simplify manufacturing of the tool and/orallow the tool to be smaller since fewer cables need be used. As shownin FIG. 49, since the same cables 914 a, 914 b, 914 c, 914 d can providearticulation and clamping, the clamping force F8 is reduced when a sideload F9 is applied and each pair of the cables 914 a, 914 b, 914 c, 914d provide a force F10.

The tool includes an energy cable 916 configured to be actuated todeliver energy to the electrodes 908 e, 910 e. The tool also includes acutting element cable 918 (see FIG. 50) configured to effecttranslational movement of a cutting element 920 along the end effector902.

In this illustrated embodiment, the tool housing 906 has six inputinterfaces with first, second, third, and fourth input interfaces forselective articulation and opening/closing of the tool's end effector902, a fifth input interface for cutting element 920 translation, and asixth input interface is available for other use. In this illustratedembodiment, the first, second, third, and fourth input interfaces arelinear mechanisms, and the fifth and sixth input interfaces are rotarymechanisms.

As shown in FIG. 50, each of the first, second, third, and fourth inputinterfaces include an articulation and closure mechanism that includes atranslational member configured to longitudinally translate to effectlongitudinal translational movement of the one of the cables 914 a, 914b, 914 c, 914 d operatively coupled thereto. FIG. 51 illustrates as arepresentative example of the four articulation and closure mechanismsone of the articulation and closure mechanisms 922 and translationalmembers 924 for one of the cables 914 b. The articulation and closuremechanism 922 also includes a bias element 926, which is in the form ofa coil spring in this illustrated embodiment, that biases its associatedcable 914 b in a distal direction. The articulation and closuremechanism 922 also includes a pulley 928 to direct motion in theappropriate distal direction. The pulley 928 is located in a centralposition between the actuator mounting points. Each of the articulationand closure mechanisms can be configured, for example, to provide about10.5 mm of translational articulation and closure cable movement, whichcan be enough to cause full articulation of the end effector 902 (e.g.,+/− about 160°).

As shown in FIGS. 50 and 52, the fifth input interface includes acutting element translation mechanism 930 that includes a gear system932 configured to effect longitudinal translational movement of thecutting element cable 918 via an auxiliary motor 936 that is geared to aleadscrew 938. The cutting element translation mechanism 930 alsoincludes a pulley 934 to direct motion in the appropriate distaldirection. Sensitivity of the cutting element translation mechanism 930can be adjusted by changing the gearing and lead screw pitch. Thecutting element translation mechanism 930 can be configured, forexample, to provide about 24 mm of cutting element translationalmovement to fully translate the cutting element fully along the endeffector 902.

FIG. 53 illustrates another embodiment of a surgical tool 940 configuredto apply energy to tissue. The tool 940 is generally configured and usedsimilar to the tool of FIGS. 46-50, e.g., includes an elongate shaft942, an end effector 944, a wrist 946 that couples the end effector 944to the shaft 942 at a distal end of the shaft 942, a tool housing (notshown) coupled to a proximal end of the shaft 942, four articulation andclosure cables 948 a, 948 b, 948 c (the fourth cable is obscured in FIG.53), a first pulley 950 operatively engaged with the first and secondcables 948 a, 948 b, a second pulley 952 operatively engaged with thethird and fourth cables 948 c, an energy cable 954, a third pulley 956operatively engaged with the energy cable 954, and a cutting elementcable (obscured in FIG. 53). In this illustrated embodiment, the wrist946 does not any pivoting linkages but instead includes a flexible neck958. The flexible neck 958 is configured to bend laterally (e.g., inleft and right directions) to facilitate articulation of the endeffector 944 laterally. The flexible neck 958 is made from one or moreflexible materials, e.g., a polyetherimide (PEI) material (such asULTEM™ resin), polyetheretherketone (PEEK), polycarbonate, nylon, highdensity polyethylene, polyester, polytetrafluoroethylene, polypropylene,polyvinylchlorideto, etc. The flexible neck 958 includes two rows ofslots 960 formed in opposite sides thereof that define first and secondopposed longitudinal spines 962 (one of the spines is obscured in FIG.53) and first and second rows of arcuate ribs 964 extending between thespines along a circumference of the flexible neck 958. Exemplaryembodiments of flexible necks are further described in U.S. Pat. No.9,402,682 entitled “Articulation Joint Features For ArticulatingSurgical Device” filed on Sep. 19, 2011, and in U.S. Pat. Pub. No.2016/0270839 entitled “Flexible Neck For Surgical Instruments” filed onMar. 16, 2015, which are hereby incorporated by reference in theirentireties.

Depending on a length of the flexible neck 958, full articulation F7 ofthe end effector 944 can take various articulation cable forces, in thisexample in which the end effector 944 has a length L1 of about 28.6 mmand an opening radius U1 of about 2.375 mm. Available articulation forceF7 in an articulation and closure cable can “use up” about 20% of theavailable force F7. To fully articulate the end effector 944 in thedirection of end effector closure or clamping, the articulation andclosure cable can travel about 8 mm. Doubling the cable force at thetool's proximal end leave about 12.5 mm of cable travel available at thetool's distal end, which is enough travel to achieve full end effectorarticulation. Without any extra forces considered (friction,articulation force), the articulation force F7 results in a clampingforce F8. If force need to articulate the flexible neck 958 is included,at full articulation the end effector clamping force is reduced.

FIG. 55 illustrates another embodiment of a surgical tool 966 configuredto apply energy to tissue. The tool 966 is generally configured and usedsimilar to the tool of FIG. 53, e.g., includes an elongate shaft (notshown), an end effector 974, a wrist 980 that couples the end effector974 to the shaft at a distal end of the shaft, a tool housing (notshown) coupled to a proximal end of the shaft, four articulation andclosure cables 968 a, 968 b, 968 c, 968 d, a first pulley (obscured inFIG. 55) operatively engaged with the first and second cables 968 a, 968b, a second pulley (obscured in FIG. 55) operatively engaged with thethird and fourth cables 968 c, 968 d, an energy cable (obscured in FIG.55), and a cutting element cable 970 for translation of a cuttingelement 972 along upper and lower jaws 976, 978 of the end effector 974.In this illustrated embodiment, the wrist 980 includes a flexible neck982, also shown in FIG. 56, that is generally configured and usedsimilar to the flexible neck 958 of the tool of FIG. 53. As shown inFIGS. 57 and 58, the flexible neck 982 has two flexion joints 984 perplane. Each of the joints 984 in this illustrated embodiment isconfigured to undergo about 40° of flexion for a total of about 80°flexion for pitch and yaw motion.

FIG. 59 illustrates another embodiment of a surgical tool 986 configuredto apply energy to tissue. The tool 986 is generally configured and usedsimilar to the tool of FIGS. 46-50, e.g., includes an elongate shaft(not shown), an end effector 988, a wrist 990 that couples the endeffector 988 to the shaft at a distal end of the shaft, a tool housing(not shown) coupled to a proximal end of the shaft, two articulation andclosure cables 992 a, 992 b, and a cutting element cable 994. The endeffector 988 includes a single spacer 996 at a distal end of alongitudinal slot 998 through which a cutting element 999 translatesalong the end effector 988, similar to the spacer 610 of FIGS. 43-44A.In this illustrated embodiment, one of the articulation and closurecables 992 a is operatively engaged with a lower jaw 988 a of the endeffector 988 by being looped around a distal end thereof, and the otherof the articulation and closure cables 992 b is operatively engaged withan upper jaw 988 b of the end effector 988 by being looped around adistal end thereof. Selective movement of one or both of the cables 992a, 992 b is configured to selectively articulate the end effector 988and open/close the jaws 988 a, 988 b.

The systems, devices, and methods disclosed herein can be implementedusing one or more computer systems, which may also be referred to hereinas digital data processing systems and programmable systems.

One or more aspects or features of the subject matter described hereincan be realized in digital electronic circuitry, integrated circuitry,specially designed application specific integrated circuits (ASICs),field programmable gate arrays (FPGAs) computer hardware, firmware,software, and/or combinations thereof. These various aspects or featurescan include implementation in one or more computer programs that areexecutable and/or interpretable on a programmable system including atleast one programmable processor, which can be special or generalpurpose, coupled to receive data and instructions from, and to transmitdata and instructions to, a storage system, at least one input device,and at least one output device. The programmable system or computersystem may include clients and servers. A client and server aregenerally remote from each other and typically interact through acommunication network. The relationship of client and server arises byvirtue of computer programs running on the respective computers andhaving a client-server relationship to each other.

The computer programs, which can also be referred to as programs,software, software applications, applications, components, or code,include machine instructions for a programmable processor, and can beimplemented in a high-level procedural language, an object-orientedprogramming language, a functional programming language, a logicalprogramming language, and/or in assembly/machine language. As usedherein, the term “machine-readable medium” refers to any computerprogram product, apparatus and/or device, such as for example magneticdiscs, optical disks, memory, and Programmable Logic Devices (PLDs),used to provide machine instructions and/or data to a programmableprocessor, including a machine-readable medium that receives machineinstructions as a machine-readable signal. The term “machine-readablesignal” refers to any signal used to provide machine instructions and/ordata to a programmable processor. The machine-readable medium can storesuch machine instructions non-transitorily, such as for example as woulda non-transient solid-state memory or a magnetic hard drive or anyequivalent storage medium. The machine-readable medium can alternativelyor additionally store such machine instructions in a transient manner,such as for example as would a processor cache or other random accessmemory associated with one or more physical processor cores.

To provide for interaction with a user, one or more aspects or featuresof the subject matter described herein can be implemented on a computerhaving a display device, such as for example a cathode ray tube (CRT) ora liquid crystal display (LCD) or a light emitting diode (LED) monitorfor displaying information to the user and a keyboard and a pointingdevice, e.g., a mouse, a trackball, etc., by which the user may provideinput to the computer. Other kinds of devices can be used to provide forinteraction with a user as well. For example, feedback provided to theuser can be any form of sensory feedback, such as for example visualfeedback, auditory feedback, or tactile feedback; and input from theuser may be received in any form, including, but not limited to,acoustic, speech, or tactile input. Other possible input devicesinclude, but are not limited to, touch screens or other touch-sensitivedevices such as single or multi-point resistive or capacitive trackpads,voice recognition hardware and software, optical scanners, opticalpointers, digital image capture devices and associated interpretationsoftware, and the like.

FIG. 60 illustrates one exemplary embodiment of a computer system 1000.As shown, the computer system 1000 includes one or more processors 1002which can control the operation of the computer system 1000.“Processors” are also referred to herein as “controllers.” Theprocessor(s) 1002 can include any type of microprocessor or centralprocessing unit (CPU), including programmable general-purpose orspecial-purpose microprocessors and/or any one of a variety ofproprietary or commercially available single or multi-processor systems.The computer system 1000 can also include one or more memories 1004,which can provide temporary storage for code to be executed by theprocessor(s) 1002 or for data acquired from one or more users, storagedevices, and/or databases. The memory 1004 can include read-only memory(ROM), flash memory, one or more varieties of random access memory (RAM)(e.g., static RAM (SRAM), dynamic RAM (DRAM), or synchronous DRAM(SDRAM)), and/or a combination of memory technologies.

The various elements of the computer system 1000 can be coupled to a bussystem 1012. The illustrated bus system 1012 is an abstraction thatrepresents any one or more separate physical busses, communicationlines/interfaces, and/or multi-drop or point-to-point connections,connected by appropriate bridges, adapters, and/or controllers. Thecomputer system 1000 can also include one or more network interface(s)1006, one or more input/output (IO) interface(s) 1008, and one or morestorage device(s) 1010.

The network interface(s) 1006 can enable the computer system 1000 tocommunicate with remote devices, e.g., other computer systems, over anetwork, and can be, for non-limiting example, remote desktop connectioninterfaces, Ethernet adapters, and/or other local area network (LAN)adapters. The IO interface(s) 1008 can include one or more interfacecomponents to connect the computer system 1000 with other electronicequipment. For non-limiting example, the IO interface(s) 1008 caninclude high speed data ports, such as universal serial bus (USB) ports,1394 ports, Wi-Fi, Bluetooth, etc. Additionally, the computer system1000 can be accessible to a human user, and thus the IO interface(s)1008 can include displays, speakers, keyboards, pointing devices, and/orvarious other video, audio, or alphanumeric interfaces. The storagedevice(s) 1010 can include any conventional medium for storing data in anon-volatile and/or non-transient manner. The storage device(s) 1010 canthus hold data and/or instructions in a persistent state, i.e., thevalue(s) are retained despite interruption of power to the computersystem 1000. The storage device(s) 1010 can include one or more harddisk drives, flash drives, USB drives, optical drives, various mediacards, diskettes, compact discs, and/or any combination thereof and canbe directly connected to the computer system 1000 or remotely connectedthereto, such as over a network. In an exemplary embodiment, the storagedevice(s) can include a tangible or non-transitory computer readablemedium configured to store data, e.g., a hard disk drive, a flash drive,a USB drive, an optical drive, a media card, a diskette, a compact disc,etc.

The elements illustrated in FIG. 60 can be some or all of the elementsof a single physical machine. In addition, not all of the illustratedelements need to be located on or in the same physical machine.Exemplary computer systems include conventional desktop computers,workstations, minicomputers, laptop computers, tablet computers,personal digital assistants (PDAs), mobile phones, and the like.

The computer system 1000 can include a web browser for retrieving webpages or other markup language streams, presenting those pages and/orstreams (visually, aurally, or otherwise), executing scripts, controlsand other code on those pages/streams, accepting user input with respectto those pages/streams (e.g., for purposes of completing input fields),issuing HyperText Transfer Protocol (HTTP) requests with respect tothose pages/streams or otherwise (e.g., for submitting to a serverinformation from the completed input fields), and so forth. The webpages or other markup language can be in HyperText Markup Language(HTML) or other conventional forms, including embedded Extensible MarkupLanguage (XML), scripts, controls, and so forth. The computer system1000 can also include a web server for generating and/or delivering theweb pages to client computer systems.

In an exemplary embodiment, the computer system 1000 can be provided asa single unit, e.g., as a single server, as a single tower, containedwithin a single housing, etc. The single unit can be modular such thatvarious aspects thereof can be swapped in and out as needed for, e.g.,upgrade, replacement, maintenance, etc., without interruptingfunctionality of any other aspects of the system. The single unit canthus also be scalable with the ability to be added to as additionalmodules and/or additional functionality of existing modules are desiredand/or improved upon.

A computer system can also include any of a variety of other softwareand/or hardware components, including by way of non-limiting example,operating systems and database management systems. Although an exemplarycomputer system is depicted and described herein, it will be appreciatedthat this is for sake of generality and convenience. In otherembodiments, the computer system may differ in architecture andoperation from that shown and described here.

Preferably, components of the invention described herein will beprocessed before use. First, a new or used instrument is obtained and ifnecessary cleaned. The instrument can then be sterilized. In onesterilization technique, the instrument is placed in a closed and sealedcontainer, such as a plastic or TYVEK bag. The container and instrumentare then placed in a field of radiation that can penetrate thecontainer, such as gamma radiation, x-rays, or high energy electrons.The radiation kills bacteria on the instrument and in the container. Thesterilized instrument can then be stored in the sterile container. Thesealed container keeps the instrument sterile until it is opened in themedical facility.

Typically, the device is sterilized. This can be done by any number ofways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).An exemplary embodiment of sterilizing a device including internalcircuitry is described in more detail in U.S. Pat. No. 8,114,345 filedFeb. 8, 2008 and entitled “System And Method Of Sterilizing AnImplantable Medical Device.” It is preferred that device, if implanted,is hermetically sealed. This can be done by any number of ways known tothose skilled in the art.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical method, comprising: receiving an inputfrom a motor of a robotic surgical system at an interface of a toolhousing of a surgical tool that includes an elongate shaft extendingdistally from the tool housing; wherein the received input causes theinterface to rotate and thereby drive longitudinal translation of acable of the surgical tool; wherein the longitudinal translation of thecable causes an end effector of the surgical tool to move relative tothe elongate shaft; and wherein the movement of the end effectorincludes at least one of opening the end effector and closing of the endeffector with the longitudinal translation.
 2. The method of claim 1,wherein the movement of the end effector includes opening of the endeffector, and the longitudinal translation of the cable is in theproximal direction.
 3. The method of claim 2, wherein the longitudinaltranslation of the cable in the proximal direction causes a slidablemember of the surgical tool to slide in a distal direction and therebycause a link of the surgical tool to pivot to open jaws of the endeffector.
 4. The method of claim 2, wherein the cable includes a firstcable and a second cable; the first cable longitudinally translating inthe proximal direction causes the opening of the end effector; themovement of the end effector also includes closing of the end effector;and the second cable longitudinally translating in the proximaldirection causes the closing of the end effector.
 5. The method of claim1, wherein the movement of the end effector includes opening of the endeffector, and the longitudinal translation of the cable is in the distaldirection.
 6. The method of claim 5, wherein the longitudinaltranslation of the cable in the distal direction causes a slidablemember of the surgical tool to slide in the distal direction and therebycause a link of the surgical tool to pivot to open jaws of the endeffector.
 7. The method of claim 5, wherein the longitudinal translationof the cable in the distal direction causes a slidable member of thesurgical tool to slide in the distal direction and thereby cause a pinto slide in a slot formed in one of two jaws of the end effector to openthe jaws.
 8. The method of claim 5, wherein the cable is engaged with apulley, and the longitudinal translation of the cable in the distaldirection causes the cable to slide around the pulley.
 9. The method ofclaim 5, wherein the movement of the end effector also includes closingof the end effector, and the longitudinal translation of the cable is inthe proximal direction.
 10. The method of claim 1, further comprisingreceiving a second input from the robotic surgical system at a secondinterface of the tool housing; wherein the second received input causesthe second interface to rotate and thereby drive longitudinaltranslation of a second cable of the surgical tool; and wherein thelongitudinal translation of the second cable in one direction causes theend effector to articulate in a first direction relative to alongitudinal axis of the elongate shaft, and longitudinal translation ofthe second cable in another, opposite direction causes the end effectorto articulate in a second direction relative to the longitudinal axis ofthe elongate shaft.
 11. The method of claim 10, wherein the interfaceincludes first and second interfaces; the input includes a first inputto the first interface and a second input to the second interface; andthe cable includes a first pair of cables operatively coupled to thefirst interface and that are driven to longitudinally translate by therotation of the first interface, and a second pair of cables operativelycoupled to the second interface and that are driven to longitudinallytranslate by the rotation of the second interface.
 12. The method ofclaim 10, wherein a flexible neck of the surgical tool that extendsbetween the elongate shaft and the end effector bends laterally tofacilitate the articulation of the end effector.
 13. The method of claim1, wherein the interface includes a rotatable winch that has the cableattached thereto.
 14. The method of claim 1, further comprising engagingtissue with the end effector; and applying energy to the tissue via theend effector.
 15. The method of claim 1, further comprising, beforereceiving the input, releasably coupling the tool housing to the roboticsurgical system.
 16. A surgical device, comprising: a tool housingincluding an interface configured to receive an input from a motor of arobotic surgical system to cause the interface to rotate; an endeffector configured to engage tissue; and a cable operatively coupled tothe interface and the end effector; wherein the rotation of theinterface in a first direction is configured to cause the cable to moveproximally and thereby cause the end effector to open; and the rotationof the interface in a second direction is configured to cause the cableto move proximally and thereby cause the end effector to close, thefirst direction being opposite to the second direction.
 17. The deviceof claim 16, wherein the cable includes a first cable and a secondcable; the device further comprises a pulley operatively coupled to thefirst cable; the rotation of the interface in the first direction isconfigured to cause the first cable to move proximally; and the rotationof the interface in the second direction is configured to cause thesecond cable to move proximally.
 18. The device of claim 16, furthercomprising a hub operatively coupled to the end effector and the cable;wherein the proximal movement of the cable causes the hub tolongitudinally slide proximally, and the distal movement of the cablecauses the hub to longitudinally slide distally.
 19. The device of claim17, further comprising a link operatively coupled to the hub; whereinthe longitudinal sliding of the hub causes the link to pivot.
 20. Asurgical device, comprising: an elongate shaft; a pair of jaws at adistal end of the elongate shaft, the pair of jaws being configured toengage tissue therebetween and apply energy thereto; a cable configuredto be actuated and thereby move in a proximal direction; a tubeconfigured to move in the proximal direction in response to the proximalmovement of the cable and thereby cause the pair of jaws to close; and acutting element cable positioned in the tube and configured to move inthe proximal direction in response to the proximal movement of the cableand thereby cause a cutting element to cut tissue engaged between thepair of jaws.
 21. The device of claim 20, further comprising a pluralityof additional cables configured to be actuated and thereby causearticulation of the pair of jaws relative to a longitudinal axis of theelongate shaft; wherein the plurality of additional cables are outsideof the tube and arranged radially around the longitudinal axis.
 22. Thedevice of claim 21, wherein the tube is configured to bend in responseto the pair of jaw being articulated, and the tube includes a pluralityof cuts therein to facilitate the bending of the tube.